Spotlight On... Power Wheelchairs

OIG agents remove unneeded wheelchairs in New Orleans

Improper payments, waste, and fraud - unfortunately, these problems are all too common in Medicare payments for power wheelchairs. To delve deeper into this matter, the Office of Inspector General (OIG) issued the series of reports examining Medicare wheelchair claims.

95 million dollars.

This is the amount that Medicare spent on claims for power wheelchairs that were either medically unnecessary or lacked sufficient documentation to determine medical necessity during the first half of 2007 alone. This represents 61 percent of Medicare claims for power wheelchairs during this period. OIG reported on these improper payments in a recently released evaluation about power wheelchairs, the fourth and final of a series. Other key findings from the series include:

Medicare and its beneficiaries paid four times the average amount paid by suppliers for standard power wheelchairs.

Eight percent of power wheelchair claims were miscoded, meaning the suppliers billed Medicare using codes that did not match the model information on the invoices of the power wheelchairs supplied to beneficiaries.

A total of 80 percent of claims for power wheelchairs did not meet Medicare coverage requirements and should not have been paid by Medicare.

Based on these findings, OIG suggested a number of recommendations to the Centers for Medicare & Medicaid Services, such as:

Continuing to educate power wheelchair suppliers and prescribing physicians to ensure compliance and

Seeking legislation to ensure that fee schedule amounts are reasonable and responsive to market changes.

Background

Beneficiaries are eligible to receive power wheelchairs under Medicare Part B coverage of durable medical equipment (DME). Beneficiaries who are prescribed power wheelchairs by their physicians receive them from DME suppliers, which bill Medicare for reimbursement. However, in order to meet Medicare guidelines, the prescribed power wheelchair must be deemed medically necessary based on a number of criteria including an algorithmic process, which determines that the power wheelchair will help the beneficiary perform Mobility-Related Activities of Daily Living and that a less expensive or different type of DME would not be appropriate. There must also be a face-to-face consultation with the prescribing physician. It is these and other standards that the latest report found were either not met or not sufficiently documented in more than half of the claims.

In addition to conducting evaluations and providing recommendations, OIG investigates and takes action against those who defraud the Medicare program. Recent power wheelchair enforcement cases include:

This Houston-area DME company, which operated under the name Tonni Medical Equipment & Supplies, submitted fraudulent claims to Medicare for medically unnecessary DME, including power wheelchairs, wheelchair accessories, and motorized scooters.

Recruiters provided the company with beneficiaries whose names were fraudulently used to bill Medicare.

The company would bill Medicare under a special code that designated the power wheelchairs as replacements for wheelchairs lost during Hurricane Katrina when in fact the hurricane did not damage the wheelchair, or the beneficiary did not even have a power wheelchair to begin with.

In 2010, the company's owner and operator, Helen Etinfoh was sentenced to 41 months in prison.

For over 3 years, owner and operator of Cooper Medical Supply, Ajibola Adekeunle Sadiqr, purchased fraudulent prescriptions and medical documents and used them to submit false claims to Medicare for expensive, high-end power wheelchairs and other DME.

Sadiqr was aware that the receiving beneficiaries did not need the power wheelchairs, and more than 80 percent of the beneficiaries lived over 100 miles away from Cooper Medical Supply.

In 2010, Sadiqr was sentenced to 55 months in prison followed by supervised release and ordered to pay $508,134 in restitution.

The owner of Los Angeles-based Positive Home Oxygen, Jeffrey C. McElveen, and his family members -- Tonia, Kelly, Stephen, and Kathy -- worked with Dr. Robert Lyle Cleveland to knowingly and willfully devise a scheme in which Dr. Cleveland signed Certificates of Medical Necessity for power wheelchairs for patients who did not meet the coverage requirements.

Positive Home Oxygen would then bill Medicare for the medically unnecessary wheelchairs.

In exchange for providing false prescriptions, Positive Home Oxygen would refer patients to Dr. Cleveland.

Jeffery McElveen was permanently excluded, or barred from participating in Medicare, Medicaid, and all other Federal health care programs. He was also sentenced to 18 months in prison and ordered to pay $200,000 in restitution.

Positive Home Oxygen received probation and was ordered to pay $809,169 in restitution.

Dr. Cleveland received home detention and probation, was ordered to pay $200,000 in restitution, and was excluded for five years.